Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions with Connection to Primary Care Within 7 Days of Hospital Discharge

Authors
Dawn Wiest
Qiang Yang
Cater Wilson
Natasha Dravid
Peer-Reviewed Article
January 2019

This resource describes the 7-Day Pledge program to reduce readmissions by increasing access to timely primary care appointments after hospitalization.

  • Previous research suggests the important role of timely primary care follow-up in reducing hospital readmissions, although effectiveness varies by program design and patients’ readmission risk level.
  • In a retrospective cohort study of hospital readmissions among adult Medicaid patients in Camden, New Jersey, patients who attended a primary care follow-up appointment had fewer 30- and 90-day readmissions compared with patients with less timely primary care follow-up or none.
  • This Quality Improvement Brief elaborates on the quality improvement aspects of the work.
  • This Clinical Redesign Brief offers guidance on how to replicate this program in other communities.
Posted to The Playbook on
Key Questions Answered
  • Is connection to primary care within seven days of hospital discharge associated with reduced readmissions?
  • What is the evidence?
Level of Evidence
Moderate
What does this mean?